What is Gout?
Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe.
Gout — a complex form of arthritis — can affect anyone. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause.
An acute attack of gout can wake you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.
Fortunately, gout is treatable, and there are ways to reduce the risk that gout will recur.
Signs & Symptoms
The signs and symptoms of gout are almost always acute, occurring suddenly — often at night — and without warning. They include:
- Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first 12 to 24 hours after it begins.
- Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
Inflammation and redness. The affected joint or joints become swollen, tender and red.
Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances that are found naturally in your body, as well as in certain foods, such as organ meats, anchovies, herring, asparagus and mushrooms.
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.
You’re more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include:
- Lifestyle factors. Choices you make in your everyday life may increase your risk of gout. Excessive alcohol use — generally more than two drinks a day for men and more than one for women — increases the risk of gout.
- Medical conditions. Certain diseases and conditions make it more likely that you’ll develop gout. These include untreated high blood pressure (hypertension) and chronic conditions such as diabetes, high levels of fat and cholesterol in the blood (hyperlipidemia), and narrowing of the arteries (arteriosclerosis).
- Certain medications. The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
- Family history of gout. If other members of your family have had gout, you’re more likely to develop the disease.
- Age and sex. Gout occurs more often in men than it does in women, primarily because women tend to have lower uric acid levels than men do. After menopause, however, women’s uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 40 and 50 — whereas women generally develop signs and symptoms after menopause.
People with gout can develop more-severe conditions, such as:
- Recurrent gout. Some people may never experience gout signs and symptoms again. But others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout.
- Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fi). Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons along the back of your ankle. Tophi usually aren’t painful, but they can become swollen and tender during gout attacks.
- Kidney stones. Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.